scholarly journals Lower extremity revascularization via endovascular and surgical approaches: A systematic review with emphasis on combined inflow and outflow revascularization

2020 ◽  
Vol 8 ◽  
pp. 205031212092923
Author(s):  
Jihad A Mustapha ◽  
Bynthia M Anose ◽  
Brad J Martinsen ◽  
George Pliagas ◽  
Joseph Ricotta ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Critical Limb Ischemia ◽  
Treatment Options ◽  
Limb Ischemia ◽  
Medical Community ◽  
Surgical Approaches ◽  
Peripheral Artery ◽  
Endovascular Revascularization ◽  
Artery Disease

This review is intended to help clinicians and patients understand the present state of peripheral artery disease, appreciate the progression and presentation of critical limb ischemia/chronic limb-threatening ischemia, and make informed decisions regarding inflow and outflow endovascular revascularization and surgical treatment options within the context of current debates in the medical community. A controlled literature search was performed to obtain research on outcomes of critical limb ischemia patients undergoing complete leg revascularization for peripheral artery disease inflow and outflow disease. Data for this review were identified by queries of medical and life science databases, expert referral, and references from relevant papers published between 1997 and 2019, resulting in 48 articles. The literature review herein indicates that endovascular revascularization—including ballooning, stenting, and atherectomy—is an effective peripheral artery disease therapy for both above the knee and below the knee disease, and can safely and effectively treat both inflow and outflow disease. As such, it plays a leading role in the therapy of lower extremity artery disease.

Multi-Level Lower Extremity Arterial Revascularization Via Retrograde Pedal Access Under Local Anesthesia in a Patient With Severe Cardiopulmonary Comorbidities: A Case Report

2021 ◽  
pp. 153857442110264
Author(s):  
Hee Korleski ◽  
Laura DiChiacchio ◽  
Luiz Araujo ◽  
Michael R. Hall
Keyword(s):  
Case Report ◽  
General Anesthesia ◽  
Peripheral Artery Disease ◽  
Critical Limb Ischemia ◽  
Treatment Modality ◽  
Conventional Treatment ◽  
Limb Ischemia ◽  
Peripheral Artery ◽  
Endovascular Revascularization ◽  
Artery Disease

Background: Chronic limb-threatening ischemia is a severe form of peripheral artery disease that leads to high rates of amputation and mortality if left untreated. Bypass surgery and antegrade endovascular revascularization through femoral artery access from either side are accepted as conventional treatment modalities for critical limb ischemia. The retrograde pedal access revascularization is an alternative treatment modality useful in specific clinical scenarios; however, these indications have not been well described in literature. This case report highlights the use of retrograde pedal access approach as primary treatment modality in a patient with an extensive comorbidities precluding general anesthesia nor supine positioning. Case Presentation: The patient is a 60-year-old female with multiple severe cardiopulmonary comorbidities presenting with dry gangrene of the right great toe. Her comorbidities and inability to tolerate supine positioning precluded her from receiving open surgery, general anesthesia or monitored sedation, or percutaneous femoral access. Rather, the patient underwent ankle block and retrograde endovascular revascularization via dorsalis pedis artery access without post-operative complications. Discussion: The prevalence of comorbidities related to peripheral artery disease is increasing and with it the number of patients who are not optimal candidates for conventional treatment methods for critical limb ischemia. The retrograde pedal access revascularization as initial treatment modality offers these patients an alternative limb salvaging treatment option.

Differences Between Patients With Intermittent Claudication and Critical Limb Ischemia Undergoing Endovascular Intervention: Insights From the Excellence in Peripheral Artery Disease Registry

2021 ◽  
Author(s):  
Kunal Patel ◽  
Yulun Liu ◽  
Farshid Etaee ◽  
Chirag Patel ◽  
Peter Monteleone ◽  
...  
Keyword(s):  
Intermittent Claudication ◽  
Peripheral Artery Disease ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Endovascular Intervention ◽  
Baseline Risk ◽  
Peripheral Artery ◽  
Disease Registry ◽  
Endovascular Revascularization ◽  
Artery Disease

Background: There are limited data on differences in angiographic distribution of peripheral artery disease and endovascular revascularization strategies in patients presenting with intermittent claudication (IC) and critical limb ischemia (CLI). We aimed to compare anatomic features, treatment strategies, and clinical outcomes between patients with IC and CLI undergoing endovascular revascularization. Methods: We examined 3326 patients enrolled in the Excellence in Peripheral Artery Disease registry from 2006 to 2019 who were referred for endovascular intervention for IC (n=1983) or CLI (n=1343). The primary outcome was 1-year major adverse limb events, which included death, repeat target limb revascularization, or target limb amputation. Results: Patients with CLI were older and more likely to have diabetes and chronic kidney disease and less likely to receive optimal medical therapy compared with IC. Patients with IC had higher femoropopliteal artery interventions (IC 87% versus CLI 65%; P <0.001), while below the knee interventions were more frequent in CLI (CLI 47% versus IC 12%; P <0.001). Patients with CLI were more likely to have multilevel peripheral artery disease (CLI 32% versus IC 15%, P <0.001). Patients with IC were predominantly revascularized with stents (IC 48% versus CLI 37%; P <0.001) while balloon angioplasty was more frequent in CLI (CLI 37% versus IC 25%; P <0.001). All-cause mortality was higher in patients with CLI (CLI 4% versus IC 2%; P =0.014). Major adverse limb event rates for patients with IC and CLI were 16% and 26%, respectively ( P <0.001) and remained higher in CLI after multivariable adjustment of baseline risk factors. Conclusions: Patients with IC and CLI have significant anatomic, lesion, and treatment differences with significantly higher mortality and adverse limb outcomes in CLI. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01904851.

Contemporary Medical Management of Peripheral Artery Disease

2021 ◽  
Vol 128 (12) ◽  
pp. 1868-1884
Author(s):  
Marc P. Bonaca ◽  
Naomi M. Hamburg ◽  
Mark A. Creager
Keyword(s):  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Critical Limb Ischemia ◽  
Cardiovascular Events ◽  
Limb Ischemia ◽  
Major Adverse Cardiovascular Events ◽  
Peripheral Artery ◽  
Walking Capacity ◽  
Medical Therapies ◽  
Artery Disease

Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis. Modifiable risk factors including cigarette smoking, dyslipidemia, diabetes, poor diet quality, obesity, and physical inactivity, along with underlying genetic factors contribute to lower extremity atherosclerosis. Patients with PAD often have coexistent coronary or cerebrovascular disease, and increased likelihood of major adverse cardiovascular events, including myocardial infarction, stroke and cardiovascular death. Patients with PAD often have reduced walking capacity and are at risk of acute and chronic critical limb ischemia leading to major adverse limb events, such as peripheral revascularization or amputation. The presence of polyvascular disease identifies the highest risk patient group for major adverse cardiovascular events, and patients with prior critical limb ischemia, prior lower extremity revascularization, or amputation have a heightened risk of major adverse limb events. Medical therapies have demonstrated efficacy in reducing the risk of major adverse cardiovascular events and major adverse limb events, and improving function in patients with PAD by modulating key disease determining pathways including inflammation, vascular dysfunction, and metabolic disturbances. Treatment with guideline-recommended therapies, including smoking cessation, lipid lowering drugs, optimal glucose control, and antithrombotic medications lowers the incidence of major adverse cardiovascular events and major adverse limb events. Exercise training and cilostazol improve walking capacity. The heterogeneity of risk profile in patients with PAD supports a personalized approach, with consideration of treatment intensification in those at high risk of adverse events. This review highlights the medical therapies currently available to improve outcomes in patients with PAD.

Characteristics and outcomes of patients with peripheral artery disease undergoing endovascular revascularization: A community hospital perspective

Vascular ◽  
2020 ◽  
pp. 170853812095885
Author(s):  
S Michael Gharacholou ◽  
Zhuo Li ◽  
Jonathan J Uy ◽  
Lee H Eckstein ◽  
Carolyn R Flock ◽  
...  
Keyword(s):  
Intermittent Claudication ◽  
Peripheral Artery Disease ◽  
Critical Limb Ischemia ◽  
Community Hospital ◽  
Limb Ischemia ◽  
Study Cohort ◽  
Acute Limb Ischemia ◽  
Peripheral Artery ◽  
Endovascular Revascularization ◽  
Artery Disease

Background There are limited data on outcomes for patients with peripheral artery disease undergoing endovascular revascularization by multi-disciplinary teams in a community hospital setting. Methods From January 2015 through December 2015, we assembled a multi-disciplinary program comprised of cardiologists, surgeons, radiologists, nurses, and administrative staff for managing patients with peripheral artery disease undergoing endovascular revascularization. Demographic, procedural, and outcomes data were collected with use of a template from the Society for Vascular Surgery Vascular Quality Initiative database. We compared characteristics and outcomes of patients with intermittent claudication and critical limb ischemia. We used Kaplan–Meier methods to estimate the rate of overall survival and freedom from rehospitalization between groups. Results After excluding patients with acute limb ischemia ( n = 5), peripheral intervention to the upper extremity ( n = 6), or abdominal aorta ( n = 11), there were 82 patients in the study cohort; 45 had intermittent claudication and 37 had critical limb ischemia. Baseline and procedural characteristics were similar between groups, although critical limb ischemia patients were more likely to have hyperlipidemia (75.7% vs. 53.3%, P = .42). Procedural success was achieved in 91.3% of cases. Actionable access site bleeding occurred in 2.4% of patients. High rates of aspirin (91.5%) and statin (87.8%) were noted at discharge. After two years of post endovascular revascularization, survival was 57.5% for critical limb ischemia patients and 94.4% for intermittent claudication patients ( P < .001). Freedom from rehospitalization was 32.7% for critical limb ischemia patients and 83.5% for intermittent claudication patients ( P < .001). Conclusions We found that favorable outcomes may be achieved with a multi-disciplinary peripheral artery disease program at community hospitals. The incorporation of quality improvement practices may further help to develop standardized and regionalized approaches to care delivery for patients with peripheral artery disease.

Abstract MP17: Galectin-3 and Subsequent Risk of Lower-extremity Peripheral Artery Disease: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Kunihiro Matsushita ◽  
Chao Yang ◽  
Shoshana H Ballew ◽  
John W McEvoy ◽  
Maya Salameh ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Limb Ischemia ◽  
Continuous Variable ◽  
Tissue Loss ◽  
Peripheral Artery ◽  
Cox Models ◽  
Galectin 3 ◽  
Table Model ◽  
Artery Disease

Background: Galectin-3 is involved in the regulation of inflammation and the formation of fibrosis and has been liked to atherosclerosis. However, there are no studies investigating prospective associations of galectin-3 with incidence of lower-extremity peripheral artery disease (PAD). Methods: Among 9,827 ARIC participants without a history of PAD, we investigated whether galectin-3 (measured at visit 4 [1996-98]) was associated with incident clinical PAD through 2013, defined as hospitalizations with PAD diagnosis or leg revascularization. We defined PAD cases with rest pain or tissue loss as critical limb ischemia (CLI). We constructed Cox models with galectin-3 modeled categorically (quartiles) and continuously (log transformed). Results: During a median follow-up of 15.8 years, 287 participants developed PAD (105 incident CLI cases). In demographically adjusted models, galectin-3 demonstrated a dose-response association with incident PAD: hazard ratios (HRs) 2.55 (95% CI 1.80-3.61) and 1.69 (1.18-2.41) for the highest and second highest quartiles, as compared to the lowest quartile (Table; Model 1). Additional adjustment for traditional cardiovascular risk factors attenuated the associations, although the highest quartile remained borderline significant (HR 1.44 [0.99-2.07], p=0.051, Table: Model 2) and galectin-3 as a continuous variable remained significant (1.15 [1.02-1.29]). Similar results were observed for the association of galectin-3 with CLI. Conclusions: Galectin-3 was modestly associated with future risk of clinical PAD events in a community-based cohort, supporting the involvement of inflammation and fibrosis in the development of clinical PAD.

scholarly journals Awareness of Scleroderma Peripheral Artery Disease Presenting With Critical Limb Ischemia in Elderly Patients

2019 ◽  
Vol 83 (5) ◽  
pp. 1081
Author(s):  
Sayaka Funabashi ◽  
Osami Kawarada ◽  
Toru Hirano ◽  
Shinobu Ayabe ◽  
Takeshi Yagyu ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Peripheral Artery Disease ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Peripheral Artery ◽  
Artery Disease
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